A 60-year-old man presents with complains of change in handwriting, tremors, rigidity and slowness of activities. The possible diagnosis is

Ans. c (Parkinson's disease). (Ref Harrison, Internal Medicine, 16th ed., 2406)PARKINSON'S DISEASE (PD)Clinical Features: # Tremors (pill rolling) 85%.# Rigidity (cog wheel/plastic)# Bradykinesia}Classical clinical triad# Others: Mask facies, Stooped posture, Micrographia, Hypophonia, Sialorrhea, Freezing/short shuttling gait, Anosmia, Akathesia, Sleep disorders, Autonomic dysfunction, Neuropychiatric symptoms# Postural instability with repeated in first year strongly suggests the diagnosis other than PD.Rx:# Dopamine agonists (pergolide, bromocriptine, ropinirole, pramipexole)# Carbidopa, levodopa# COMT inhibitors (tolcapone, entacapone)# MAO inhibitors (selegiline)# Quetiapine# Clozapine# Anticholinergics: Trihexiphenidyl (benzhexol), Procyclidine, Benztropine, Biperiden (drug of choice in drug induced parkinsonism).# Amantadine# Anti-glutameric (riluzole) .... Primarily used in Rx of ALS# Minocycline# Co enzyme Q10.